Systems and methods for a dual control surgical instrument

ABSTRACT

A method comprises receiving a surgical instrument into engagement with a grip actuator of a teleoperational activation system. The surgical instrument includes movable jaws, and the surgical instrument is received in a prearranged gripping configuration with the jaws gripping a surgical accessory. The method includes generating a first control signal for manipulating the surgical instrument while maintaining the surgical instrument in the prearranged gripping configuration. The method further includes generating a second control signal for manipulating the surgical instrument to move from the prearranged gripping configuration to a second configuration.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application61/726,415 filed Nov. 14, 2012, which is incorporated by referenceherein in its entirety.

FIELD

The present disclosure is directed to surgical systems and methods foruse in minimally invasive teleoperational surgery, and more particularlyto systems and methods for implementing a dual-control surgicalinstrument.

BACKGROUND

Minimally invasive medical techniques are intended to reduce the amountof extraneous tissue that is damaged during diagnostic or surgicalprocedures, thereby reducing patient recovery time, discomfort, anddeleterious side effects. Minimally invasive telesurgical systems havebeen developed to increase a surgeon's dexterity and to avoid some ofthe limitations on traditional minimally invasive techniques. Intelesurgery, the surgeon uses some form of remote control, e.g., aservomechanism or the like, to manipulate surgical instrument movements,rather than directly holding and moving the instruments by hand. Intelesurgery systems, the surgeon can be provided with an image of thesurgical site at the surgical workstation. While viewing a two or threedimensional image of the surgical site on a display, the surgeonperforms the surgical procedures on the patient by manipulating mastercontrol devices, which in turn control motion of the servomechanicallyoperated instruments.

In telesurgery, the surgeon typically operates a master controller tocontrol the motion of surgical instruments at the surgical site from alocation that may be remote from the patient (e.g., across the operatingroom, in a different room, or a completely different building from thepatient). The master controller usually includes one or more hand inputdevices, such as hand-held wrist gimbals, joysticks, exoskeletal glovesor the like, which are operatively coupled to the surgical instrumentsthat are releasably coupled to a patient side surgical manipulator (“theslave”). The master controller controls the instrument's position,orientation, and articulation at the surgical site. The slave is anelectro-mechanical assembly which includes a plurality of arms, joints,linkages, servo motors, etc. that are connected together to support andcontrol the surgical instruments. In a surgical procedure, the surgicalinstruments (including an endoscope) may be introduced directly into anopen surgical site or more typically through cannulas into a bodycavity.

For minimally invasive surgical procedures, the surgical instruments,controlled by the surgical manipulator, may be introduced into the bodycavity through a single surgical incision site or through multipleclosely spaced incision sites on the patient's body. These minimallyinvasive procedures may present multiple challenges. For example, someprocedures that require the manual introduction of surgical implementssuch as sutures, gauze, sponges, clamps, and needles. may require theuse of separate instruments. A teleoperated instrument may be removedfrom the surgical manipulator and a manual instrument inserted into thepatient to hand off a surgical accessory to another teleoperatedinstrument. The manual instrument is then removed so that theteleoperated instrument may be reintroduced. This type of hand offprocedure is time consuming and requires the use of separate manual andteleoperated instruments. Improved systems and methods are needed toimprove efficiency in procedures that involve the introduction ofsurgical implements, while maintaining safety and accuracy throughoutthe surgery.

SUMMARY

The embodiments of the invention are summarized by the claims thatfollow below.

In one embodiment, a method comprises receiving a surgical instrumentinto engagement with a grip actuator of a teleoperational activationsystem. The surgical instrument includes movable jaws, and the surgicalinstrument is received in a prearranged gripping configuration with thejaws gripping a surgical accessory. The method includes generating afirst control signal for manipulating the surgical instrument whilemaintaining the surgical instrument in the prearranged grippingconfiguration. The method further includes generating a second controlsignal for manipulating the surgical instrument to move from theprearranged gripping configuration to a second configuration.

In another embodiment, a surgical system comprises an instrument bodyincluding an end effector sized to grip a surgical accessory and adual-control instrument activation system coupled to the instrumentbody. The dual-control instrument activation system includes a leveroperable, in response to manual manipulation, to move between a firstposition in which the end effector is in an open configuration forreceipt of a surgical accessory and a second position in which the endeffector is in a closed gripping configuration. The surgical systemfurther comprises an instrument operation system responsive toteleoperational signals. The instrument operation system includes alever capture mechanism to engage the lever in the second position tomaintain the closed gripping configuration. The lever capture mechanismalso moves the lever to the first position.

In another embodiment, a surgical system comprises an instrumentincluding an end effector sized to grip a surgical accessory. Thesurgical system also comprises a dual-control instrument activationsystem to control the end effector. The dual-control instrumentactivation system includes a ratchet assembly coupled to a lever. Inresponse to manual manipulation, the lever moves the ratchet assembly toa gripping position in which the end effector is arranged to grip thesurgical accessory. The surgical system also comprises an instrumentoperation system that is responsive to teleoperational signals. Theinstrument operation system includes a lever capture mechanism to engagethe lever to move the ratchet assembly to a release position in whichthe end effector is arranged to release the surgical accessory.

BRIEF DESCRIPTIONS OF THE DRAWINGS

Aspects of the present disclosure are best understood from the followingdetailed description when read with the accompanying figures. It isemphasized that, in accordance with the standard practice in theindustry, various features are not drawn to scale. In fact, thedimensions of the various features may be arbitrarily increased orreduced for clarity of discussion. In addition, the present disclosuremay repeat reference numerals and/or letters in the various examples.This repetition is for the purpose of simplicity and clarity and doesnot in itself dictate a relationship between the various embodimentsand/or configurations discussed.

FIG. 1 illustrates a schematic view of a teleoperated surgical systemaccording to one embodiment of the present disclosure.

FIG. 2 illustrates a diagrammatic perspective view of a patient sidemanipulator according to one embodiment of the present disclosure.

FIG. 3 illustrates a perspective view of a cluster of surgicalinstruments for use with the teleoperated surgical system of FIG. 2.

FIG. 4 is a partially schematic illustration of a dual-control surgicalinstrument according to an embodiment of this disclosure.

FIG. 5 illustrates a side view of a dual-control surgical instrumentwith an end effector in a closed position according to one embodiment ofthe present disclosure.

FIG. 6 illustrates a side view of the dual-control surgical instrumentof FIG. 5 with the end effector in an open position according to oneembodiment of the present disclosure.

FIG. 7 is a partial cross-section view of the instrument of FIGS. 5 and6.

FIG. 8 is a partial internal view of the dual-control surgicalinstrument of FIGS. 5 and 6.

FIG. 9 is a partial side view of the dual-control surgical instrument ofFIGS. 5 and 6 coupled to a grip actuator.

FIG. 10 is a flow chart illustrating a method of operating adual-control surgical instrument according to another embodiment of thepresent disclosure.

FIG. 11 illustrates a partial side view of a dual-control surgicalinstrument according to another embodiment of the present disclosure.

FIG. 12 illustrates a partial side view of a dual-control surgicalinstrument according to another embodiment of the present disclosure.

DETAILED DESCRIPTION

In the following detailed description of the embodiments of theinvention, numerous specific details are set forth in order to provide athorough understanding of the disclosed embodiments. However, it will beobvious to one skilled in the art that the embodiments of thisdisclosure may be practiced without these specific details. In otherinstances well known methods, procedures, components, and circuits havenot been described in detail so as not to unnecessarily obscure aspectsof the embodiments of the invention.

FIG. 1 illustrates a schematic view of a teleoperated surgical system 10according to one embodiment of the present disclosure. The system 10includes a master surgeon console or workstation 12 for inputting asurgical procedure and a patient side cart (or “PSC”) 14 for movingsurgical instruments, via teleoperational control, at a surgical sitewithin a patient. The teleoperated surgical system 10 is used to performminimally invasive teleoperated surgery. One example of a teleoperatedsurgical system that can be used to implement the systems and techniquesdescribed in this disclosure is a da Vinci® Surgical Systemcommercialized by Intuitive Surgical, Inc. of Sunnyvale, Calif. Thoseskilled in the art will understand that the inventive aspects disclosedherein may be embodied and implemented in various ways, includingteleoperated and non-teleoperated embodiments and implementations.Implementations on da Vinci® Surgical Systems are merely exemplary andare not to be considered as limiting the scope of the inventive aspectsdisclosed herein. Further details of these exemplary teleoperatedsurgical systems are provided, for example, in pending U.S. patentapplication Ser. No. 12/855,461, the full disclosure of which isincorporated herein by reference.

The system 10 is used by a system operator, generally a surgeon, whoperforms a minimally invasive surgical procedure on a patient. Thesystem operator sees images captured by an image system 16 and presentedfor viewing at the master console 12. In response to the surgeon's inputcommands, a computer system 18 effects servomechanical movement ofsurgical instruments coupled to the teleoperated patient-sidemanipulator system 14 (a cart-based system in this example).

Computer system 18 will typically include data processing hardware andsoftware, with the software typically comprising machine-readable code.The machine-readable code will embody software programming instructionsto implement some or all of the methods described herein. While computersystem 18 is shown as a single block in the simplified schematic of FIG.1, the system may comprise a number of data processing circuits (e.g.,on the surgeon's console 12 and/or on the patient-side manipulatorsystem 14), with at least a portion of the processing optionally beingperformed adjacent an input device, a portion being performed adjacent amanipulator, and the like. Any of a wide variety of centralized ordistributed data processing architectures may be employed. Similarly,the programming code may be implemented as a number of separate programsor subroutines, or may be integrated into a number of other aspects ofthe teleoperated systems described herein. In one embodiment, computersystem 18 may support wireless communication protocols such asBluetooth, IrDA, HomeRF, IEEE 802.11, DECT, and Wireless Telemetry.

The PSC 14 may be mobile (e.g., including wheels) or stationary. PSC 14includes a manipulator arm 20 that effects movement of a surgicalinstrument 22 for manipulation of tissues. An instrument operationsystem 24 is coupled to the manipulator arm 20 and includes actuationcomponents to control the movement of the surgical instrument 22. Theinstrument 22 includes a dual-control instrument activation system 26and an instrument body 28. As will be described in greater detail below,the instrument body 28 may include a shaft and an end effector. Thedual-control instrument activation system 26 functions as an actuatingcomponent of the instrument operation system 24 but is separable fromother actuating components of the instrument operation system. When thesurgical instrument 22 is decoupled from the instrument operation system24, the dual-control instrument activation system 26 may be used tomanually control the operation of the surgical instrument 22.

For example, a surgical assistant may decouple a gripping surgicalinstrument and dual-control instrument activation system 26 from theinstrument operation system 24. The assistant may manually manipulatethe dual-control instrument activation system 26 to cause the surgicalinstrument to grip a surgical accessory such as a needle or a clamp. Thesurgical assistant may then reconnect the dual-control instrumentactivation system 26 and surgical instrument, now gripping the surgicalaccessory, to the instrument operation system 24. The instrumentoperation system 24, via the dual-control instrument activation system26, maintains the grip of the surgical instrument on the surgicalaccessory while the surgical instrument is moved into and within thesurgical site. Thus, the dual-control instrument activation system 26may be controlled by manual operator inputs and by teleoperationalinputs.

The actuation components of the instrument operation system 24 mayinclude a grip output controlling a gripping end effector, a joggleoutput controlling the side-to-side and up-down motion of the endeffector, a wrist output controlling yaw and pitch motions of the endeffector, and a roll output controlling a roll output of the endeffector. Components for one or more of these actuations may be includedin the dual-control instrument activation system 26.

The PSC may include all of the actuation components, including motors,the power sourced and control systems, that control the instrument. Inalternative embodiments, some or all of the motors may be in theinstrument with the PSC supplying the power and the control signals tothe instrument. In still another alternative, the instrument may bebattery powered with the PSC providing only control signals to theinstrument

FIG. 2 illustrates a diagrammatic perspective view of a PSC 100according to an illustrative embodiment of the PSC 14 described abovewith reference to FIG. 1. In this embodiment, the PSC 100 includes afloor-mounted base 102. The base may be movable or fixed (e.g., to thefloor, ceiling, wall, or other sufficiently rigid structure). Base 102supports an arm assembly 104. The arm assembly 104 includes activejoints and links for manipulator arm configuration and movement,instrument manipulation, and instrument insertion.

The arm assembly 104 includes a manipulator assembly disk or platform106. An instrument cluster 108 is mounted to platform 106. The center ofplatform 106 is coincident with a manipulator assembly roll axis 110, asshown by the dashed line that extends through the center of manipulatorplatform 106. The instrument cluster 108 includes instrument shafts 108a mounted to instrument actuators 108 b. Each instrument shaft 108 a ismounted on a distal face of an instrument actuator 108 b, in oneembodiment.

As shown in FIG. 3, instrument cluster 108 includes four instrumentactuators 108 b. Each instrument actuator 108 b supports and actuates anassociated surgical implement. For example, one instrument actuator 108b is configured to actuate a camera instrument, and three instrumentactuators 108 b are configured to actuate various other interchangeablesurgical end effectors that perform surgical and/or diagnostic work atthe surgical site. Articulated end effectors may include jaws, scissors,graspers, needle holders, micro-dissectors, staple appliers, tackers,suction irrigation tools, and clip appliers, that may be driven by wirelinks, eccentric cams, push-rods. or other mechanisms. In addition, thesurgical instruments may comprise a non-articulated instrument, such ascutting blades, probes, irrigators, catheters or suction devices.Alternatively, the surgical tool may comprise an electrosurgical probefor ablating, resecting, cutting or coagulating tissue. Examples ofapplicable adaptors, tools or instruments, and accessories are describedin U.S. Pat. Nos. 6,331,181, 6,491,701, and 6,770,081, the fulldisclosures of which (including disclosures incorporated by referencetherein) are incorporated by reference herein for all purposes.Applicable surgical instruments are also commercially available fromIntuitive Surgical, Inc. of Sunnyvale, Calif. More or fewer instrumentactuators may be used. In some operational configurations, one or moreactuators may not have an associated surgical instrument during some orall of a surgical procedure.

The instruments 108 are mounted so that shafts 108 a are clusteredaround manipulator assembly roll axis 110. Each shaft 108 a extendsdistally from the instrument's force transmission mechanism, and allshafts may extend through a single cannula placed at a port into thepatient surgical site. Each instrument actuator 108 b is movable toallow insertion and withdrawal of the surgical instrument(s).

FIG. 4 is a partially schematic illustration of a dual-control surgicalinstrument 150 according to an embodiment of this disclosure. Instrument150 is an illustrative embodiment of an instrument 22, 108 describedabove with reference to FIGS. 1 and 3, respectively. The dual-controlsurgical instrument 150 includes a parallel motion mechanism 152 with atube 153 having joints at each end, coupled to a wrist joint 154, whichis coupled to the end effector 156. In this embodiment, the end effector156 includes jaws 158. In some aspects, the parallel motion mechanism152 and wrist joint 154 function such that the position of a referenceframe at the distal end of the mechanism may be changed with respect toa reference frame at the proximal end of the mechanism without changingthe orientation of the distal reference frame. Details of an applicableparallel motion assembly including related joints of an applicableinstrument are further disclosed in U.S. patent application Ser. No.11/762,165 filed Jun. 13, 2007, disclosing “Minimally Invasive SurgicalSystem” and U.S. Pat. No. 7,942,868 filed Jun. 13, 2007, disclosing“Surgical Instrument with Parallel Motion Mechanism,” which areincorporated by reference herein in their entirety.

The parallel motion mechanism 152 is coupled to a distal end of a shaft160. The proximal end of the shaft 160 is coupled to an instrument body163. A lever 162 is coupled to the body 163 by a pivot joint 165. Aswill be described in other embodiments, the lever 162 may be manually orteleoperationally actuated. The lever 162 is coupled to a drive element164. In this embodiment, the drive element is a single rod 164 which maybe formed of nitinol, stainless steel, or another suitable medical-grademetal, ceramic, or polymer. Alternatively, the rod 164 may include morethan one material. For example, a more flexible material may be used inareas that extend through the joints. In one embodiment, a distalportion of the rod may include a tungsten cable with an ethylenetetrafluoroethylene (ETFE) covering and a proximal portion formed ofstainless steel. Optionally, a fluorinated ethylene propylene (FEP)covering may extend over all or a portion of the rod. The rod 164 mayextend through the shaft 160 to couple with the end effector 156. Inthis embodiment, counter-clockwise rotation of the lever 162 about thepivot joint 165 advances the rod 164 linearly (i.e., moves the rod inthe distal direction) to open the jaws of the end effector 156.Clockwise rotation of the lever 162 about the pivot joint 165 retractsthe rod 164 linearly (i.e., moves the rod in the proximal direction) toclose the jaws of the end effector 156. In an alternative embodiment,the rotation of the lever may have the opposite influence on the rod(i.e. counter-clockwise rotation retracts the rod and clockwise rotationadvances the rod). In various embodiments, the rod may be configuredsuch that advancement may either open or close the end effector.Likewise, the retraction may either open or close the end effector. Theinstrument 150 also includes a securing component 166 (e.g., one or moresprings, a ratchet mechanism) which holds or biases the lever 162 in aposition such that the jaws of the end effector 156 are held in aprearranged gripping position without a manual or teleoperated actuatorproviding a force to the lever. The lever 162 may be actuated by a forcereceived by an actuator 168. The force provided by the actuator 168 mayovercome the securing force provided by the securing component 166 tomove the lever 162 and thus move the end effector from the prearrangedclosed gripping configuration to a released open configuration.

FIG. 5. illustrates a side view of a dual-control surgical instrument200 with an end effector 202 in a closed position. Instrument 200 is anillustrative embodiment of an instrument 22, 108 described above withreference to FIGS. 1 and 3, respectively. The dual-control surgicalinstrument 200 includes a parallel motion mechanism 204 with a tube 207having joints at each end, coupled to a wrist joint 203, which iscoupled to the end effector 202. In this embodiment, the end effector202 includes jaws 205. In some aspects the parallel motion mechanism 204and wrist joint 203 function such that the position of a reference frameat the distal end of the mechanism may be changed with respect to areference frame at the proximal end of the mechanism without changingthe orientation of the distal reference frame. Details of an applicableparallel motion assembly including related joints of an applicableinstrument are further disclosed in U.S. patent application Ser. No.11/762,165 filed Jun. 13, 2007, disclosing “Minimally Invasive SurgicalSystem” and U.S. Pat. No. 7,942,868 filed Jun. 13, 2007, disclosing“Surgical Instrument with Parallel Motion Mechanism,” which areincorporated by reference herein in their entirety.

The parallel motion mechanism 204 is coupled to a distal end of a shaft206. The dual-control surgical instrument 200 further includesdual-control instrument activation system 208. The proximal end of theshaft 206 is coupled to a dual-control instrument activation system 208.The system 208 includes a lever 210 pivotally connected to a housing 212by a pivot connector 214. In this embodiment, the dual-controlinstrument activation system 208 is operational to open and close theend effector 202 in response to pivotal movement of the lever 210. Asshown in FIG. 6, the lever 210 is rotated (clockwise in this embodiment)about the pivot connector 214 to open the gripping end effector 202 toreceive a surgical accessory such as a needle 215. The lever 210 isrotated in the opposite direction (counter-clockwise in this embodiment)to close the end effector 202 to firmly grasp the needle 215 within thejaws 205 of the end effector. The lever 210 may be manually operated bya user or may be manipulated by a teleoperated actuator as will bedescribed below. In an alternative embodiment, the rotation of the levermay have the opposite influence on the rod (i.e. counter-clockwiserotation advances the rod and clockwise rotation retracts the rod). Invarious embodiments, the rod may be configured such that advancement mayeither open or close the end effector. Likewise, the retraction mayeither open or close the end effector.

FIG. 7 is a partial cross-sectional view and FIG. 8 is a partialinternal view of the dual-control instrument activation system 208. Inthese views, the lever 210 is biased toward the position shown in FIG.5, in which the end effector 202 is closed. The lever 210 is biased by aspring 216, which in this embodiment is a coil spring. In alternativeembodiments, other biasing elements, including other types of springs,elastomeric material components, or shape-memory material elements maybe used. The lever 210 is coupled to a drive element 218 by a clamp 220.In this embodiment, the drive element is a single rod 218 which may beformed of nitinol, stainless steel, or another suitable medical-grademetal, ceramic, or polymer. Alternatively, the rod 218 may include morethan one material. For example, a more flexible material may be used inareas that extend through the joints. In one embodiment, a distalportion of the rod may include a tungsten cable with an ETFE coveringand a proximal portion formed of stainless steel. Optionally, an FEPcovering may extend over all or a portion of the rod. The rod 218 mayextend through the housing 212 and through the shaft 206 to couple withthe end effector 202. The clamp 220 grips the rod 218 and can rotatewithin the lever 210 to avoid excess bending of the rod. In thisembodiment, clockwise rotation of the lever 210 compresses the spring216 and advances the rod 218 linearly in the direction 222 to open thejaws of the end effector 202. Counter-clockwise rotation of the lever210 retracts the rod 218 linearly in the direction 224 to close the jawsof the end effector 202. The bias of the spring 216 may be sufficientlystrong that the rod 218 will be biased to return to the closed positionif the lever is not held in the open position by an outside force. Inalternative embodiments, the dual-control instrument activation systemmay bias the end effector to an open position.

The 208 further includes a driver holder 226 and a spring 228 whichapplies gentle axial compression on the driver holder 226. A cylindricalbearing 230 holds the spring 228 in place within the housing 212. Theactivation system 208 further includes gimbal assemblies (e.g., 234 inFIG. 8, others not shown) and other mechanisms which operate cables,rods or other drive mechanisms (not shown) to actuate the roll, parallelmotion, and wrist joint components through the translation of pitch,yaw, and roll movements. Further aspects of the gimbal assemblies foruse in teleoperated surgical activation systems may be found in U.S.patent application Ser. No. 12/060,104 filed Mar. 31, 2008, disclosing“Coupler to Transfer Controller Motion from a Robotic Activation systemto an Attached Instrument;” U.S. patent application Ser. No. 11/762,165filed Jun. 13, 2007, disclosing “Minimally Invasive Surgical System;”and U.S. patent application Ser. No. 12/780,758 filed May 14, 2010,disclosing “Force Transmission for Robotic Surgical Instrument,” whichare incorporated by reference herein in their entirety. Some gimbalassemblies may be horizontally arranged gimbal assemblies that functionto translate or copy inputs from one gimbal assembly to anotherhorizontally aligned gimbal assembly via a translation components.Translation components may include gears, levers, cables, pulleys, cableguides or other components to transfer or copy the mechanical motionbetween gimbal assemblies. Other gimbal assemblies may be verticallyarranged gimbal assemblies that function to translate inputs from onegimbal assembly to another vertically aligned gimbal assembly.Translation components such as those described above may be used totransfer the mechanical motion between vertically arranged gimbalassemblies.

In this embodiment, the drive rod 218 that actuates the grasping actionof the end effector 202 passes through a central opening in verticallyaligned gimbal assemblies. In alternative embodiments, the drive element218 may be a pair of cables, where one is pulled to open the jaws of theend effector and one is pulled to close the jaws of the end effector. Insome embodiments, the gripping drive element 218 may be amulti-component drive element with, for example, a rigid or semi-rigidrod at the proximal end near the lever and a more flexible component atthe distal end where the drive element passes through the parallelmotion mechanism and wrist joints. The flexible component of the rod maybe a thin wire (e.g., nitinol), a coated or uncoated cable, or a pair ofcoated cables that cooperate together. As the flexible component passesthrough the parallel motion mechanism and/or the wrist joints, a sheathmay be used to prevent buckling. Alternatively, the flexible componentsmay be guided by the inner diameters of the parallel motion mechanismand/or wrist joints.

As shown in FIG. 9, the dual-control instrument activation system 208can be a component of an instrument operation system 250. The instrumentoperation system 250 also includes a grip actuator 252 which couples toand moves the lever 210 about the pivot connector 214. The grip actuatorinclude rotary and/or linear motion encoders 254. One or more motors256, such as servomotors, drive an associated ball screw 258, whichmoves an actuator housing 260 linearly forward or backward along a pathgenerally parallel to the axis of the ball screw 258. A lever capturemechanism 262, which in this embodiment has a hook shape, is sized toreceive and couple with an end portion of the lever 210. In alternativeembodiments, the capture mechanism may be a socket, a clamp, or othermechanism configured to hold and move the lever 210. A bias component264, such as a spring, is housed within the actuator housing 260 andexerts a biasing force that presses the lever capture mechanism 262toward the lever 210. A support slide 266 provides linear support to thegrip actuator 252.

The surgical instrument 200 may be used for minimally invasiveteleoperated surgery performed through multiple surgical incisions orthrough a single incision. As shown in FIG. 10, a flow chart 300illustrates a method of operating the surgical instrument 200. Duringthe course of a teleoperational surgical procedure, a surgeon may desireto introduce a surgical accessory such as a needle, gauze, a sponge, aclamp, or other useful accessory into the surgical site. At step 302, auser, such as a surgical assistant, grasps the surgical accessory 215within the jaws of the end effector 202 by moving the lever 210 aboutthe pivot connector 214 to compress the spring 216. The movement of thelever 210 advances the rod 218, causing the jaws of the end effector 202to open. The surgical assistant then places the surgical accessory 215between the jaws of the end effector 202. The surgical assistantreleases the lever 210, allowing the lever to return to a prebiasedposition corresponding to a closed position of the end effector 202. Aclosed position includes the configurations of the end effector 202 inwhich the jaws 205 are closed onto or around the surgical accessory orare in closed contact with each other. The surgical instrument 200 isnow in a prearranged gripping configuration with the surgical accessorygripped between the jaws of the end effector 202.

At step 304, the surgical assistant couples the surgical instrument 200to the grip actuator 252. More specifically, the grip actuator 252receives the end of the lever 210 in the lever capture mechanism 262.The instrument 200 remains in the closed gripping configuration whilethe end effector 202 and the gripped surgical accessory 216 areintroduced into the surgical site. The introduction of the instrument200 and the surgical accessory 215 may be through a cannula and/or othertypes of access ports leading into the surgical site in the patient.

At step 306, the surgical instrument 200 is moved by the operationsystem 250 while the instrument continues to grip the surgical accessory215. One or more control signals are generated by and sent from thecomputer system 18 to instruct the operation system to maintain thesurgical instrument in the gripping configuration. While the grip ismaintained, the parallel motion mechanism 204 or the wrist joint 203 maybe moved, causing the gripped surgical accessory 215 to be moved intoposition within the surgical site. To release or readjust the surgicalaccessory 215, at step 308, the instrument is moved from the closedgripping configuration to a release or loosened grip configuration. Oneor more control signals are generated by and sent from the computersystem 18 to instruct the operation system to move from the closedgripping configuration to an open or loosened configuration. Morespecifically, the grip actuator 252 moves the lever capture mechanism262, causing the captured lever 210 to pivot about the pivot connector214 to open or loosen the jaws of the end effector 202.

In an alternative embodiment, the surgical accessory may be a devicethat should be introduced into the surgical site in a held-openconfiguration. For example, a surgical clip may need to be held openuntil it surrounds a blood vessel to be occluded. In this embodiment, aninstrument that includes a clip applier may be introduced with the clipapplier held in an open position. A user may manually manipulate thedual-control activation system to grip the clip applier and an attachedsurgical clip in an open gripping position. The dual-control activationsystem may be transferred to the control of the instrument operationsystem with the dual-control activation system continuing to be held inthe open gripping position. The dual-control activation system may bebiased toward an open position. Alternatively, the dual-controlactivation system may be biased toward a closed position with theoperator and teleoperated forces applied to maintain the instrument inthe open position against the bias.

In still another alternative, the dual-control activation system may beactuated manually even after it is attached to the teleoperatedinstrument operation system. Such an embodiment may be used, forexample, to deliver a manual force more powerful than can be deliveredby the motors of the PSC. One such example of a manual override may befor a large stapler that requires a short burst of force that may bemost efficiently provided with manual actuation rather than withteleoperated actuation.

FIG. 11 illustrates a partial side view of a dual-control surgicalinstrument 400 according to another embodiment of the presentdisclosure. Instrument 400 is an illustrative embodiment of aninstrument 22, 108 described above with reference to FIGS. 1 and 3,respectively. The dual-control surgical instrument 400 includes aparallel motion mechanism 402, coupled to a wrist joint 404, which iscoupled to an end effector 406. In this embodiment, the end effector 406includes jaws 408. The parallel motion mechanism 402 is coupled to adistal end of a shaft 410. The proximal end of the shaft 410 is coupledto an actuator 414 which is pivotally connected to a housing (not shown)by a pivot connector 418. The actuator 414 includes an elongated slot420 sized to receive an elongated portion of a ratchet button 422. Aratchet pin 424 is coupled to or integrally formed at a distal end ofthe ratchet button 422. A toothed ratchet arm 426 is coupled to thehousing. The teeth of the ratchet arm 426 are sized to receive theratchet pin 424 therebetween. A spring 427 extends between the ratchetbutton 422 and the actuator 414. A lever 428 is pivotally connected tothe actuator 414. Alternatively the lever 428 could be connected to thehousing. A drive member 432, which in this embodiment is a rod, isclamped to the actuator 414 by a clamp 434.

In one example of use, the ratchet button 422 is depressed (for example,manually) causing the pin 424 to move from between a pair of teeth ofthe ratchet arm 426. The actuator 414 is pivoted clockwise about thepivot connector 418 and the rod 432 is retracted, moving the jaws 408 toa closed configuration. With the button 422 released and the spring 427relaxed, the pin 424 is biased into engagement with the ratchet arm 426and the rod 432 is locked in position with the jaws 408 in the closedconfiguration.

The movement of the rod 432 may be transferred to teleoperatedinstrument control while maintaining the jaws 408 in the closed andlocked position. For example, an instrument activation system (manual orteleoperated) including a biasing member 430 (e.g., a spring-loadedplunger) and a grip actuator 436 may be used to control the instrument400. The lever 428 is engaged by the grip actuator 436 and is pivotedclockwise while the biasing member 430 provides a reaction force againstthe movement of the actuator 414. The clockwise motion of the lever 428eventually engages and depresses the button 422, releasing the pin 424from the ratchet arm 426, thus allowing the further movement of the 436to rotate the actuator 414 about the pivot connector 418 eitherclockwise to retract the rod 432 to close the jaws 408 orcounter-clockwise to advance the rod and open the jaws. The biasingmember 430 biases the actuator 414 to an advanced position in which thejaws 408 are open.

FIG. 12 illustrates a partial side view of a dual-control surgicalinstrument 450 according to another embodiment of the presentdisclosure. The surgical instrument 450 is similar to the instrument 400of FIG. 400 and similar components will retain the same referencenumerals. In this embodiment, an actuation component 452 provides aforce on the actuator 414 and an actuation component 454 provides aforce on the button 422. The actuation components 452, 454 may beseparate actuation components or may be part of a common actuationcomponent. When the actuation component 454 depresses the button 422 torelease the pin 424 from the ratchet arm 42 and the activation system452 exerts a force on the actuator 414, the actuator 414 moves clockwiseand depresses the bias member 430. The actuator 414 thus retracts therod 432 and the jaws 408 are closed. When the force provided by theactivation system 452 is withdrawn or lessened while the pin 424 isdisengaged from the ratchet arm 426, the bias member 430 moves theactuator counter-clockwise, and the rod 432 is advanced, opening thejaws 408. In the embodiment of FIG. 12, the surgical instrument 450 maybe locked and unlocked, repeatedly, by the activation system 454 using adedicated actuator (e.g., a motor or solenoid). In FIG. 11, when theinstrument 400 is unlocked by lever 428, it remains unlocked.

While certain exemplary embodiments of the invention have been describedand shown in the accompanying drawings, it is to be understood that suchembodiments are merely illustrative of and not restrictive on the broadinvention, and that the embodiments of the invention not be limited tothe specific constructions and arrangements shown and described, sincevarious other modifications may occur to those ordinarily skilled in theart.

What is claimed is:
 1. A method comprising: receiving a surgicalinstrument into engagement with a grip actuator of a teleoperationalactivation system, wherein the surgical instrument includes movable jawsand wherein the surgical instrument is received in a prearrangedgripping configuration with the jaws gripping a surgical accessory;generating a first control signal for manipulating the surgicalinstrument while maintaining the surgical instrument in the prearrangedgripping configuration; and generating a second control signal formanipulating the surgical instrument to move from the prearrangedgripping configuration to a second configuration.
 2. The method of claim1 wherein the prearranged gripping configuration is a closed grippingconfiguration of the jaws.
 3. The method of claim 1 wherein theprearranged gripping configuration is an open gripping configuration ofthe jaws.
 4. The method of claim 1 wherein maintaining the surgicalinstrument in the prearranged gripping configuration includes engaging alever of the surgical instrument with the grip actuator.
 5. The methodof claim 4 wherein moving from the surgical instrument from theprearranged gripping configuration to the second configuration includesmoving the lever with the grip actuator.
 6. The method of claim 5wherein moving the surgical instrument from the prearranged grippingconfiguration to the second configuration includes operating a motor tomove the lever.
 7. The method of claim 1 wherein moving the surgicalinstrument from the prearranged gripping configuration to the secondconfiguration includes compressing a spring.
 8. The method of claim 1wherein moving the surgical instrument from the prearranged grippingconfiguration to the second configuration includes adjusting a ratchetmechanism.
 9. The method of claim 1 wherein moving the surgicalinstrument from the prearranged gripping configuration to the secondconfiguration includes actuating the jaws to releasing a grip on thesurgical accessory.
 10. A surgical system comprising: an instrument bodyincluding an end effector sized to grip a surgical accessory; adual-control instrument activation system coupled to the instrumentbody, wherein the dual-control instrument activation system includes alever operable, in response to manual manipulation, to move between afirst position in which the end effector is in an open configuration forreceipt of a surgical accessory and a second position in which the endeffector is in a closed gripping configuration; and an instrumentoperation system responsive to teleoperational signals and including alever capture mechanism configured to engage the lever in the secondposition to maintain the closed gripping configuration and furtherconfigured to move the lever to the first position.
 11. The surgicalsystem of claim 10 wherein the dual-control instrument activation systemincludes a rod coupled between the end effector and the lever.
 12. Thesurgical system of claim 10 wherein the dual-control instrumentactivation system includes a spring adapted to bias the lever to thegripping position.
 13. The surgical system of claim 12 wherein thespring is configured to move to a compressed configuration when thelever is moved to the first position.
 14. The surgical system of claim10 wherein the instrument operation system includes a motor configuredto move the lever to the first position.
 15. The surgical system ofclaim 10 wherein the lever capture mechanism includes a springactuation.
 16. A surgical system comprising: an instrument including anend effector sized to grip a surgical accessory; a dual-controlinstrument activation system adapted to control the end effector, theactivation system including a ratchet assembly coupled to a lever,wherein, in response to manual manipulation, the lever is adapted tomove the ratchet assembly to a gripping position wherein the endeffector is arranged to grip the surgical accessory; and an instrumentoperation system responsive to teleoperational signals and including alever capture mechanism configured to engage the lever to move theratchet assembly to a release position wherein the end effector isarranged to release the surgical accessory.
 17. The surgical system ofclaim 16 wherein the ratchet assembly includes a pin, a gear, and aspring loaded button, wherein the button is adapted to move the pinrelative to the gear in response to movement of the lever.
 18. Thesurgical system of claim 16 wherein the dual-control instrumentactivation system includes a rod coupled between the end effector andthe ratchet assembly.
 19. The surgical system of claim 16 wherein thedual-control instrument activation system includes a servomotor operablycoupled to the lever capture mechanism.
 20. The surgical system of claim16 wherein the lever is adapted to move the ratchet assembly between aplurality of gripping positions, wherein each of the gripping positionscorresponds to a respective grip arrangement of the end effector.